Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jul 21, 2010; 16(27): 3423-3426
Published online Jul 21, 2010. doi: 10.3748/wjg.v16.i27.3423
Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?
Paulo Herman, Marcos V Perini, Vincenzo Pugliese, Julio Cesar Pereira, Marcel Autran C Machado, William A Saad, Luiz AC D’Albuquerque, Ivan Cecconello
Paulo Herman, Marcos V Perini, Vincenzo Pugliese, Julio Cesar Pereira, Marcel Autran C Machado, William A Saad, Luiz AC D’Albuquerque, Ivan Cecconello, Department of Gastroenterology, Hospital Das Clínicas - University of São Paulo Medical School, São Paulo - SP - CEP 05403-000, Brazil
Paulo Herman, Praça Santos Coimbra, 10, São Paulo - SP - CEP 05614-050, Brazil
Author contributions: Herman P, Machado MAC and Perini MV designed the study and wrote the manuscript; Pereira JC carried out the statistical analysis; Pugliese V, Saad WA, D’Albuquerque LAC and Cecconello I performed the corrections and revised the manuscript.
Correspondence to: Paulo Herman, MD, PhD, Praça Santos Coimbra, 10, São Paulo - SP - CEP 05614-050, Brazil. pherman@uol.com.br
Telephone: +55-11-37272355 Fax: +55-11-38841142
Received: January 14, 2010
Revised: March 25, 2010
Accepted: April 2, 2010
Published online: July 21, 2010
Abstract

AIM: To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis. Prognostic factors, especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.

METHODS: Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection. Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct (> 2 cm). Late results and risk factors for recurrence of symptoms or stones were evaluated.

RESULTS: There was no operative mortality. After a mean follow-up of 50.3 mo, good late results were observed in 82.9% of patients; all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms (P = 0.0006). Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%, respectively (P < 0.001).

CONCLUSION: Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution. Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct.

Keywords: Biliary lithiasis; Bilioenteric anastomosis; Cholangitis; Intrahepatic lithiasis; Liver resection